Ep. 49: History of the Provincial Lunatic Asylum, Part 3 (1907-present)

In this episode, we discuss the last century of history at the Provincial Lunatic Asylum, now called the Centre for Addiction and Mental Health (CAMH). Find out about the murder that led to the "trial of the century" and sparked public interest in learning about insanity and psychiatry. Learn what methods of treatment were used at the hospital before the advent of psychotropic medications. And discover how CAMH is currently serving its community.

All sources are listed at the end of the episode transcript.

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The Silver King's War is a series of World War II plays (The Silver King, Marauder Men,...

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Transcript

Hello, hello, hello, and welcome back to Behind the Walls of the World’s Psychiatric Hospitals! I’m your host, Dr. Sarah Gallup, and today we’re going to wrap up the history of the Provincial Lunatic Asylum at 999 Queen Street West in Toronto. At this point in the story, the hospital has gone from being the lunatic asylum to the asylum for the insane to now the hospital for the insane. You can see those incremental changes in the way that mental illness was understood and perceived.

Trigger warnings include a brief story about sexual assault and murder, a description of Metrazol shock therapy, and outdated clinical terminology.

My main sources for this episode include information from the Center for Addiction and Mental Health website and an article on the Queen Street site on the website “After the Asylum.” All other sources will be listed at the end of the episode transcript.

For now, come on in and get comfortable as we go behind the walls of the Provincial Lunatic Asylum…

We left off last time in 1907, after the asylum had been renamed the Hospital for the Insane. Remember that the intent was to show that it was a place where people could receive treatment rather than simply being warehoused.

It was interesting that just a few years earlier, in 1905, Superintendent Clark had recommended that the asylum be sold and relocated, due to chronic overcrowding, poor maintenance of the facility, and the city crowding in around it (“History of Queen Street Site”). But that idea was rejected, most likely due to budget constraints, since that had been the issue for years.

Instead of selling, Dr. Clark decided to strengthen the ties that the hospital had with the University of Toronto Medical School. Years earlier, while Dr. Workman was still superintendent, he had established a residency program with the medical school so that the asylum could be a training site for medical students. Dr. Clark took this one step further and established an in-house training center for nurses in addition to doctors-in-training (“History of Queen Street Site”).

Around this time, public interest in the treatment of insanity around Toronto arose following a notorious crime that occurred in New York City. So I’m going to deviate for a moment to tell the story of this crime and how it affected public perception of mental illness in Canada.

The crime itself took place on June 25, 1906, when Harry Thaw, the son of a coal and railroad baron, murdered renowned architect Stanford White (who, by the way, has the biggest and bushiest mustache I’ve ever seen), but the story begins long before the murder. Trigger warning here for sexual assault. Skip forward about 30 seconds if you don’t want to hear it.

Sometime before 1905 – it’s not entirely clear when this happened – architect Stanford White approached 16 year old Evelyn Nesbit, who was a model and chorus girl – and began giving her alcohol and other substances. She became intoxicated and, after she had passed out, White raped her (“Harry Kendall Thaw”).

Evelyn Nesbit would go on to meet and fall in love with Harry Thaw, the son of the coal and railroad baron. When he asked her to marry him, she said no, she couldn’t. She then shared with him her story of being assaulted by White. To Harry Thaw, Stanford White had “ruined” Evelyn, whom he would eventually marry, and Thaw developed a deep-seated hatred for White that would persist for years (“Harry Kendall Thaw”).

Since Thaw was heir to a multimillion dollar fortune, he was destined for life in high society. He applied to all the elite men’s clubs – the Metropolitan Club, the Century Club, the Knickerbocker Club, the Players’ Club – but all rejected him. Rightly or wrongly, Thaw was convinced that Stanford White was to blame (“Harry Kendall Thaw”). He believed White was deliberately preventing him from being part of high society, and ohhhh, he hated him.

Now we get to the night of June 25, 1906. Thaw and Evelyn stopped in New York City before going on a European holiday. They stopped to see a play on the rooftop theatre of Madison Square Garden. Around 11 pm, who wandered in to take his place at his usual seat but Stanford White. Thaw was agitated. He walked over to White then withdrew hesitantly. He repeated this a couple of times before pulling out a pistol, pointing it at White, and shooting him three times and killing him instantly. I should remind you: this was a play performance – there were people all around when this happened. Thaw stood over White’s body, holding the gun in the air, and said, “I did it because he ruined my wife! He had it coming to him! He took advantage of the girl and then abandoned her!” Witnesses would later say they weren’t sure if he had said “ruined my wife” or “ruined my life,” but I think the point stays the same. Later, when he found his wife and she asked what happened, Thaw replied, “It’s all right; I probably saved your life.” (“Harry Kendall Thaw”)

The subsequent trial for Harry Thaw became known as the trial of the century. Everyone tuned in, and everyone was talking about it. Thaw had had a history of alcohol and drug abuse and was a bit of a philanderer himself, so doctors were quick to point to the potential of insanity as a cause of the murder. While Thaw was sitting in jail awaiting trial – with, I should add, a doctor’s “prescription” for daily champagne and wine, as well as a fancy brass bed – he reported hearing the “heavenly voices of young girls calling to him, which he interpreted as a sign of divine approval.” He fully believed that the public would see him as the hero who had rid the world of Stanford White (“Harry Kendall Thaw”).

The first trial ended with a hung jury. The second trial was actually the first time in American history that jury members were sequestered because the case had received so much media attention. Thaw pleaded temporary insanity at the time of the crime, and the jury seemed to agree. He was found not guilty by reason of insanity and sentenced to life at Matteawan State Hospital for the Criminally Insane in Fishkill, New York (“Harry Kendall Thaw”).

There is so much more that could be said about this case, but what I want you to take from it is the sensation that it caused around the country and around the world. The trial took place in 1907, the same year that the asylum in Toronto became a “hospital.” This is also around the same time that Sigmund Freud was putting forth his theories on psychosexuality, including the phases of psychosexual development, the Oedipus complex, and the Electra Complex. So suffice it to say that there is a lot of chatter even among lay folk about this new field of psychiatry and Harry Thaw and how it all fit into the medical field.

So in what seems like an attempt to educate the public on psychiatry and insanity, the Toronto Star published a short article on November 22, 1907, that broke it down. The article references the hospital in Munich. Just a reminder because we talked about it wayyyy back in episode 11 that this was the hospital where Emil Kraeplin, who coined the term “dementia praecox,” studied. It was also where Dr. Alois Alzheimer studied and where Dr. Henry Cotton from Trenton State Hospital studied. You may remember (or have already blocked out) that he was the guy who believed infected teeth and organs led to insanity, so he just pulled people’s teeth and cut out their organs. If you haven’t listened to those episodes yet, you should. Start with episode 10 on the founding of the New Jersey State Lunatic Asylum.

Anyway, so the understanding of psychiatry as a field wasn’t well known to ordinary folks, so an article from the Toronto Star explains it as follows: 

Newspaper readers are becoming familiarized with the word “psychiatry,” a word which, if not new in science, is new in ordinary conversation. On turning up the dictionary they find that it means simply the treatment of mental diseases. But more specifically it is associated with the treatment of the insane in hospitals. It conveys the idea that “insane people are sick people, and hospital treatment means nursing in bed – sick people belong there.” As the modern asylum is a vast improvement on the old madhouse, so the psychiatric hospital, the hospital for the insane, represents another stage in the progress of the humane and scientific ideas in the treatment of insanity. Its purpose is to treat the disease of insanity thoroughly in the early stages; to educate the medical man into recognizing the period of development; to discover by scientific research new means of detection and cure. At the Munich hospital, which is regarded as the model institution, investigations are going on as to the nature of general paresis; and the statement is made that “the day will come when this dread and now incurable disease will be just as amenable to treatment and control as diphtheria.” (“Hospitals for the Insane”)

It goes on a bit to discuss the Munich hospital, which isn’t particularly relevant here, but then picks up with a reference to the Thaw trial – the trial of the century.

A very important feature of the work at Munich is the provision made for the study of those criminals whose mental status is questioned. The Thaw trial furnishes an instance of the unseemly wrangles that occur in court where the plea of insanity is raised. Doctors give varying testimony, and their fights with the cross-examining counsel are more amusing than edifying. At Munich the accused person is carefully observed for six weeks, and the best judgment is then given that science can arrive at.

Another benefit that would accrue from the careful treatment in early stages is the prevention of insanity. This matter, with others, is dealt with in the very interesting bulletin issued by the Rockwood Hospital for the Insane. The use of the name hospital, and the contents of the bulletin, show the progress that psychiatry is making in Ontario. It is henceforth to be recognized in the University of Toronto, and there is reason to hope that we are on the eve of a movement which will greatly mitigate the saddest of all human afflictions. (“Hospitals for the Insane”)

Well, it was good until that last time. “The saddest of all human afflictions”: mental illness. I don’t know about that. But this shows the discussion at least in the newspapers of mental illness and the progress that was being made in the early 20th century.

A few years later, in September 1913, there was another article, this time in the Star Weekly, that referenced the current state of hospitals for the insane and the Harry Thaw case. Spoiler alert: Thaw eventually escaped from the hospital where he had been sentenced, so that little incident sparked even more conversations about where the criminally insane should be housed.

What I like about this article is how it begins to poke holes in the theory that people committed to insane asylums deserve to remain there. Here’s what it says after the discussion of Thaw’s escape:

Of course, in the interests of the public, it is necessary to take precautions to prevent escape. But there may be worse evils than the occasional escape of a mental defective not criminaly [sic] disposed. For example, I have known several instances of persons confined in hospitals for the insane making their escape, and subsequently obtaining employment, and making good. These instances give one occasion for pause. One cannot help wondering how many patients there are who are detained in these hospitals who would really make good outside. Undoubtedly there must be many, just as there are many people outside who would be better in.

“The tendency of to-day in dealing with mental defectives is to give them courage and confidence – to help them, too, to an insight into the nature of their own malady. We are still, perhaps, only on the threshold of the right way of treating this disease. But the public mind certainly needs to be better educated on the question. It wants to be taught to regard the mental defective in a more human light, and not merely as a person to be shrunk from or feared. Where at all possible, the object should be to relax, not to increase, restraints.” (“Could insane criminals…”)

Okay, maybe a starting place would be not calling patients “mental defectives,” as if they’re a completely separate class of people? “They want to regard the mental defective in a more human light…” Again, they are human. They’re trying – getting a little closer.

I won’t read the rest of the article, but it quotes a local medicine man as they call this guy who discusses a sort of probation program from the hospital back to the community that has been effective for many patients. It sounds like the very early genesis of community-based care. And again, that article was from 1913.

Of course, by 1914 the world gets involved in World War I. As we’ve discussed with other hospitals, the Toronto Hospital for the Insane is directly impacted by the war effort. Many staff are sent to provide medical care in the field. Fortunately, thanks to the foresight of Superintendent Clark, the training program for nurses at the hospital turned out an additional 120 psychiatric nurses in 1914 to be added to hospitals and asylums around the province (“Nurses for Insane…”). The timing was impeccable.

As veterans returned with Shell Shock, the number of patients at the Toronto Hospital for the Insane continued to grow, but the building wasn’t getting any larger or in any better condition. By 1918, the government was essentially forced to allocate funds to build another hospital for the insane in Whitby, northeast of Toronto (“Ontario saved…”). Originally, the Whitby hospital was intended to replace the hospital at 999 Queen St, but that just didn’t happen (“History of the Queen Street Site”).

By 1919, the hospital had a total patient population of 1,270 (“Queen Street”). In an attempt to further destigmatize the treatment patients received there, it was once again renamed – this time the Ontario Hospital of Toronto (“History of the Queen Street Site”), so no mention of insanity or lunacy or any of that. 

The hospital made strong efforts around this time period to incorporate new approaches to treatment of mental illness. During the 1910s and 1920s, social workers and occupational therapists were added to hospital staff. By 1927, the first occupational therapy graduates from the University of Toronto were hired (“Queen Street”). And these folks made some pretty incredible initial strides toward discharging patients who did not need to be at the hospital. Some of the former inpatient units at the Queen Street Site were converted into day care and self-care programs. Day care in this sense means for the patients transitioning into community living (“Queen Street”).

The hospital also developed an off-campus industrial therapy workshop to help patients learn vocational skills that they could use once they left the hospital. Up to 60 day care patients were supervised by staff members and were employed by subcontract work (“Queen Street”). That’s pretty innovative for the late 1920s.

Just a few years later, in 1933, a “boarding home” was introduced that allowed outpatients coming from 999 Queen Street to live semi-independently while being monitored by the hospital (“Queen Street”).

Unsurprisingly, though, there was a mix of good and bad during this time. The 1930s and 40s also saw the introduction of Metrazol and insulin shock therapies, in addition to electroshock therapy. We discussed Metrazol shock in Episode 20 on Ionia State Hospital, but I’ll briefly revisit it here.

Now, interestingly, there was a newspaper article about the introduction of Metrazol shock therapy, and while it did explain the process, it left out some horrific details. Here’s what it says:

Metrazol, as applied to the insanities, was discovered by Dr. von Meduna, of Budapest, Hungary, in 1933. [This article is from 1938] […] Metrazol is a white powder, soluble in water, tasteless and chemically neutral, and can be sterilized without deterioration. It looks rather like talcum powder and is not – contrary to common belief – a derivative of camphor. [Obviously. Everyone knows Metrazol isn’t a derivative of camphor]

It is injected into the blood stream at the elbow joint and epileptic convulsions result within 30 seconds in most cases. This lasts for a couple of minutes, during which the patient shows all the signs of an epileptic seizure, the yawning being so pronounced that the jaw has to be held to prevent dislocation.

Following this the patient enters a stupor, which lasts for about 15 minutes, and may seem confused and unable to adjust himself for about half an hour.

In Ontario hospitals the treatments are given in the morning, and throughout the afternoon, patients show marked improvement, offering better co-operation to nursing care, becoming friendlier, having better appetites and, after a certain number of treatments, taking keen interest in sports and recreational opportunities. (“Drug causes convulsions…”)

What this article fails to include is mention of the restraints needed to hold down the patient during their induced seizure. It does mention holding the jaw in place to prevent dislocation, but this wasn’t the only way they needed to subdue the patient. I hate thinking about this procedure, but imagine someone lying on a surgical table, surrounded by doctors and nurses, and their hands and legs are cuffed to prevent them from flailing. The doctors induce a grand mal seizure, and every staff member holds down the patient’s limbs to keep them still. The problem was that the seizures and restraints would cause patients to have fractured bones, broken teeth, spinal fractures, torn muscles, hemorrhages in the brain or other vital organs (Goeres-Gardner 145). One patient described it as “being roasted alive in a white hot furnace” (145). And patients would go through these treatments three times per week. You’d better believe I’d be cooperating with staff and eating and doing whatever I had to do to avoid going through that again.

But it had to be worth it, right? To put patients through this procedure three times per week for five weeks? The article boasts that the treatment has only caused nine deaths out of 2,000. And the cure rate? Out of an average of 20 patients, 5 were cured. About 11 didn’t see any benefits, but those five – they got to go home (“Drug causes convulsions…”). It baffles me how much they were willing to overlook torture of patients for a 25% cure rate. Of course, we don’t really know how we’ll react in a given situation, but I imagine that if I were aware of this procedure and were being taken from my room to undergo Metrazol treatment, I would probably resist every step of the way.

And yet somehow, even with the rise of these new treatments, there were more and more patients voluntarily and involuntarily being committed to hospitals. The growing number of patients necessitated the construction of additional insane hospitals around Ontario. In 1939, a new hospital opened in St. Thomas, which was about 200 km southwest of Toronto. And this doesn’t really have anything to do with our hospital in Toronto, but I wanted to read part of the newspaper article that seemed to promote (question mark?) this new hospital. This was taken from The Toronto Star, October 3, 1938:

Ontario’s new temple of light is rising, brick upon brick, out of the flat farmlands on the outskirts of this town. This is a temple where light will conquer darkness, where science will wrestle with the ancient problem of insanity. The latest addition to the chain of Ontario hospitals for the mentally afflicted is expected to open early next spring. (“New Mind Hospital…”)

And, flowery language aside, it seems to get more bizarre as it continues:

The St. Thomas Ontario hospital, built in the modern manner with windows instead of walls, will, in fact, bring light into the shadowy lives of the mind-sick thousands it will serve. By administering treatment in bright, airy wards; by taking advantage of every fragment of sunlight every day, psychiatrists will have every physical advantage within the giving of architectural science. (“New Mind Hospital…”)

This next part is my favorite. This is the newspaper attempting to spin the grills on windows as aesthetically pleasing:

With so many windows it became necessary to provide protection for the patients. To make the hospital safe without using prison-type bars, a handsome metal grillwork was designed. Every window through which a body could squeeze is protected by these grills, in a neo-Italian pattern, actually making the buildings more attractive. (“New Mind Hospital…”)

Spoiler alert: they’re not more attractive. Many hospitals built during this time had these same grills. They look very prison-like. But points for trying, I guess.

Now, the interesting thing about this article is the description that this new hospital will be a “temple of light” with windows all over. Then I looked at a picture, and…well, at least the front entryway looks like a brutalist style building. It looks like concrete slabs with some circular windows thrown in. Not the temple of light that I was expecting. But it was a very large hospital and would expand to house almost 2500 patients -- 1000 morethan the Ontario Hospital at Toronto did at its peak (“Queen Street”).

Surprisingly, there aren’t many changes to the hospital during WWII, as we’ve seen with other hospitals. Some other Ontario Hospitals were repurposed into military hospitals but I didn’t see evidence that the hospital in Toronto did this.

In the mid-1950s, construction began on an administration building that would sit directly in front of 999 Queen St. site. In 1956, this building was complete. Two years later, the hospital began offering additional occupational therapy, physiotherapy, and psychotherapy (“History of the Queen Street Site”). This was also when psychotropic medications were introduced, which helped facilitate the discharge of patients who were able to return to the community.

The 1960s saw a significant amount of change for the Ontario Hospital at Toronto. In 1964, the Ontario Ministry of Health announced plans to replace the hospital at 999 Queen Street with a new structure. They hoped this would usher in a new era of mental health treatment. And the timing couldn’t be better: 1965 saw the highest patient population in its history with 1,392 patients (“Queen Street”). Remember that the original building, even with the later addition of wings, was only estimated to house 400-500 patients. But a change made in 1960 would help ease the overcrowding for good. It was in 1960 that the Department of Health established a Rehab Branch with the goal of providing inpatient and post-hospital help. The website “After the Asylum” describes the expansion of the Rehab Branch: 

Though the branch developed educational and training services in 1966, the organization recognized that formal technical training institutes were inadequate for the needs of patients discharged from a hospital for the mentally ill. To fill this gap, “Operation New Start” was introduced with a strong emphasis on the rehabilitative needs of mentally ill patients. One such program authorized “industrial rehabilitation centres” within all Ontario hospitals, enabling hospital superintendents to employ patients for work in their hospitals. Under this policy, programs operated on a six-hour workday, five days per week, and patients were paid for their labour (Pollock). Similarly, the Vocational Rehabilitation Act allowed for the further development of workshops and other training programs that provided an incentive and support to enable people with mental illnesses to reside in their own homes. In 1967, an amendment to the Secondary Schools Act required school boards to provide services to those deemed “trainable retarded.” (“Queen Street”)

To show the progress in treatment, the hospital was once again renamed. In 1966, it was renamed Queen Street Mental Health Centre. The following year, the hospital launched three satellite community service programs that would help ease the transition for inpatients returning to the community. These changes were part of an initiative later called “Putting People First,” which hoped to radically reform mental health services in Ontario (“Queen Street”).

By the early 1970s, construction on what would become the new hospital had started. By 1972, Active Treatment Units 1 and 2 had opened, as well as the Paul Christie Community Centre. Two years later, Active Treatment Units 3 and 4 were complete. And, by 1976, the original asylum building was finally torn down (“History of the Queen Street Site”), 126 years after it had opened. But something was lingering. Something still didn’t feel quite right.

For years the address of 999 Queen Street West was stigmatized. Parents threatened to send naughty children to 999 Queen. The address itself was stuck in the past, so in 1979, the hospital was rededicated and changed its address to 1001 Queen Street West as a symbolic gesture of disconnecting with the past and starting fresh (“History of the Queen Street Site”). A press release after the dedication said the following:

[G]one now are all the vestiges of an earlier time when mental illness was something that society kept out of sight—the high wall that encircled the grounds and effectively isolated patients from the outside world, corridors that reeked of an atmosphere of listlessness and boredom, and heavily screened windows that contributed to the prison image. In their place stands a facility that reflects the new thinking on the treatment of mental illness, a policy that opens doors both for the patient and the community. (Qtd. in “Queen Street”)

And the initiatives and reforms that had been taking place during the 60s and 70s were doing what they intended to do: transitioning patients from the hospital to the community. Remember I mentioned a few minutes ago that the hospital reached its peak patient population in 1965 with just under 1400 patients? Only 10 years later, there were 339 patients remaining in the hospital. Everyone else had successfully moved to outpatient care and transitional housing (“Queen Street”).

Fast forward to 1998. The hospital expands to merge with other nearby clinics -- the Clarke Institute of Psychiatry, the Addiction Research Foundation, and the Donwood Institute – and is renamed the Centre for Addiction and Mental Health or CAMH.

Today, CAMH is the largest psychiatric teaching hospital in Canada, and it reports being the largest research facility in Canada for mental health and addictions (“Centre for Addiction and Mental Health”). Interestingly, it was research conducted at CAMH that led to the discovery of the dopamine receptor D2 (“Centre for Addiction and Mental Health”). If you’re not familiar with dopamine, that’s the neurotransmitter that I explain to my patients as the one that sends “feel good” signals. When we do something that gives us pleasure, we get a burst of dopamine. So when I see my furry friends snuggling and I say, “Awww,” I get a burst of feel-good dopamine. D2 receptors, however, are the main receptor for antipsychotic drugs, so this is what is believed to help manage symptoms of psychosis (“Dopamine receptor D2”).

True to its roots, CAMH continues to have inpatient, outpatient, day treatment, and partial hospitalization for people with mental illness. It is also home to the only stand-alone psychiatric emergency department in Ontario (“Centre for Addiction and Mental Health”). 

And that’s where I’ll end the history of the Provincial Lunatic Asylum. Next time I will have patient stories from the 1800s to see what life was like at the asylum from those who lived there. I hope you’ll come back to listen to those stories!

As always, thank you so much for listening! I really appreciate it. Be sure to rate and review wherever you are listening – that helps other people find the show. Check out the Facebook group (Behind the Walls Podcast) and Instagram page (@behindthewallspod) for more content and information. You can also check out the Beacons and Patreon pages for other ways to connect with and support the show.

But most of all, remember: “Do the best you can until you know better. Then, when you know better, do better.” Until next time…

“Centre for Addiction and Mental Health.” Wikipedia. https://en.m.wikipedia.org/wiki/Centre_for_Addiction_and_Mental_Health

“Could Insane Criminals of Canada Emulate H.K. Thaw?” Star Weekly, 6 Sept. 1913, p. 10.

“Dopamine Receptor D2.” Wikipedia. https://en.m.wikipedia.org/wiki/Dopamine_receptor_D2

“Drug Causes Convulsions for Treatment of Insane.” The Toronto Star, 28 May 1938, p. 11.

Goeres-Gardner, Diane L. Inside Oregon State Hospital. The History Press, 2013.

“Harry Kendall Thaw.” Wikipedia. https://en.m.wikipedia.org/wiki/Harry_Kendall_Thaw

“History of Queen Street Site.” Centre for Addiction and Mental Health. https://www.camh.ca/en/driving-change/building-the-mental-health-facility-of-the-future/history-of-queen-street-site

“Hospitals for the Insane.” The Toronto Star, 22 Nov. 1907, p. 8.

“New Mind Hospital Lets Light into Dark Places.” The Toronto Star, 3 Oct. 1938, p. 9.

“Nurses for Insane Pass Examinations.” The Toronto Star, 29 May 1914, p. 13.

“Ontario Saved $1,751,374 in Fiscal Year 1916-1917.” The Toronto Star, 13 Feb. 1918, p. 5. 

“Queen Street.” After the Asylum. Madness, Canada, 2019. https://aftertheasylum.ca/policy-and-practice/the-last-asylums/queen-street/